From the Guidelines
Prognosis for Low-Grade Prostate Cancer
The prognosis for low-grade (Gleason score 6 or lower) prostate cancer is generally favorable, with a high likelihood of long-term survival and low risk of cancer progression, as indicated by studies such as 1 and 1.
- Patients with low-grade prostate cancer often have a 10-year overall survival rate of approximately 90% or higher, depending on various factors including life expectancy, general health condition, and disease characteristics, as suggested by 1 and 1.
- Active surveillance is a common management approach for low-grade prostate cancer, involving regular monitoring of the disease with the expectation to intervene with potentially curative therapy if the cancer progresses, as recommended by 1 and 1.
- Treatment options for low-grade prostate cancer may include radical prostatectomy, external beam radiotherapy, brachytherapy, and active surveillance, with the choice of treatment depending on individual patient factors and preferences, as discussed in 1 and 1.
- The NCCN Guidelines define low-risk prostate cancer as tumors with a Gleason score of 6 or less, serum PSA level below 10 ng/mL, and clinical stage T1 to T2a, and recommend observation, active surveillance, or treatment with curative intent depending on the patient's life expectancy and other factors, as outlined in 1 and 1.
- It is essential to weigh the potential benefits and harms of different treatment options and to consider individual patient factors, including life expectancy, general health condition, and disease characteristics, when making treatment decisions for low-grade prostate cancer, as emphasized by 1 and 1.
From the Research
Prognosis for Low-Grade Prostate Cancer
The prognosis for low-grade prostate cancer, defined as a Gleason score of 6 or lower, is generally favorable.
- Studies have shown that active surveillance is a suitable management approach for patients with low-risk disease, avoiding long-term adverse effects on quality of life 2, 3.
- The natural history of low-risk prostate cancer is characterized by a low risk of metastatic dissemination, with many cases being clinically insignificant and not requiring treatment 4.
- Long-term outcomes for active surveillance have shown excellent metastasis-free survival and overall survival rates, with a cancer-specific mortality rate of 3% at 10 to 15 years 2.
- However, some studies have reported that active surveillance may be associated with a slightly higher risk of metastasis, overall mortality, and prostate cancer-specific mortality compared to initial treatment 5.
Factors Influencing Prognosis
Several factors can influence the prognosis of low-grade prostate cancer, including:
- Gleason score: A score of 6 or lower is generally considered low-risk 2, 3.
- PSA level: A level of less than 10 ng/mL is typically considered low-risk 2, 3.
- Molecular alterations: Some low-grade cancers may have molecular alterations that can cause progression to more aggressive disease 2, 3.
- Patient selection: Active surveillance is generally recommended for patients with low-risk disease, while radical treatment may be reserved for cases with higher-risk disease 2, 3.
Management and Outcomes
The management of low-grade prostate cancer typically involves:
- Active surveillance: Close monitoring with digital rectal examination, periodic biopsy, and serial PSA testing 2, 3.
- Focal therapy: Aims to preserve tissue and function in men with localized disease, and may be offered as an alternative to whole-gland radiation or surgery 3.
- Radical treatment: May be reserved for cases with higher-risk disease or those that progress to more aggressive disease 2, 3.
- Long-term outcomes: Active surveillance has been shown to have excellent long-term results, with low rates of metastasis and cancer-specific mortality 2, 5, 6.